Case Study

The Danish prison servicePlan for the future provision of health care service to citizens in prisons and detention centres

The Danish Prison Service and Implement Consulting Group

Authors

The challenge

As a rule, the Danish health authorities are responsible for the provision of health care services to Danish citizens. But this rule does not apply when it comes to the prison service. For security reasons – and given the unique institutional setting that inmates find themselves in – the Danish prison service is responsible for providing such services to the people in their custody. In Denmark, this amounts to almost 4,000 inmates – out of a total population of 5.7 million. They are detained in around 50 different prisons and detention centres distributed across four prison service districts.

While serving their sentence, inmates must have access to medical treatment and other health care services similar to, and of the same quality as, those available to the general population. In larger closed prisons and detention centres, for instance, the prison services typically have nurses, doctors, psychiatrists, dentists and physiotherapists employed to provide health care services to inmates. In smaller detention centres and open prisons, however, it is primarily the local GPs in the area that take care of these services. Whether serving a sentence in a large or small facility, all inmates can get a check-up or medical treatment in a hospital if they need to.

In recent years, the prison service has noted a number of inefficiencies in the health care service that they provide to inmates in their care. These shortcomings relate to:

  • inconsistencies in the health care system
  • lack of a health professional environment, and
  • lack of professional standards for treatment and task handling.

Results

In collaboration with the Danish prison service, Implement has analysed how to organise health care services in prisons and detention centres – to achieve a consistent and effective handling of tasks.

To arrive at these recommendations, we have:

  • identified and analysed the prison service’s current provision of health care – in terms of the type of services provided, their scope, organisation and management
  • defined a realistic target for future health care services
  • looked to other countries for inspiration to see how they organise their health care services for inmates, and
  • described scenarios for the future provision of health care services in Denmark.

While addressing current challenges, these scenarios must also allow for timely diagnosis and treatment, the running of effective operations and take into account the unique institutional setting that the prison service represents.

The analysis and recommendations include reflections on which role the general health care system should play in the future, how the prison service can work systematically to ensure the quality and effectiveness of their health care services for inmates, and how they can build an appropriate relation between the services they provide themselves and those they outsource to private health care providers.

We submitted the report in June 2016. The Danish prison service can use the results for further consideration and definition of strategic choices.

Facts

According to health care workers in the Danish prison service, 50 – 70 per cent of inmates receive medical treatment.

The study, Screening of inmates for somatic diseases – a survey of the health care service provided by the prison service and the state of health of inmates, undertaken in selected institutions, documented that:

  • 90 per cent of inmates have at least one diagnosis – either a somatic disease or a psychiatric disease with somatic implications (typically related to movement, teeth, drug abuse or asthma).
  • 35 per cent of inmates are registered with at least one psychiatric diagnosis (typically drug abuse-related and ADHD).

The Screening project for psychiatric disease, undertaken in selected detention centres, documented that:

  • 91 per cent of inmates have a psychiatric disease or other psychiatric conditions. 41 per cent of these relate to drug abuse.